運用社會資源及視訊協助一位子宮頸癌婦女達成最後心願之護理經驗

A NURSING EXPERIENCE OF HELPING A WOMAN WITH CERVICAL CANCER ACHIEVE HER WISHES THROUGH SOCIAL RESOURCES AND VIDEO TELEPHONE

本文描述ㄧ位40 歲子宮頸癌婦女因感受死亡及無法與案子道別等威脅，引發因應能力失調及靈性困擾的護理經驗。個案2003 年2 月因子宮頸癌至2010 年10 月做過化療2 次、放射治療1 次，此次因為腰背疼痛及陰道持續出血1 個月，在高雄無人照顧經由家鄉鄰居協助至本院治療。護理期間自2011 年10 月2 日至24 日於內科病房，筆者依其生理、心理、社會及靈性層面做整體性的評估，並藉由運用會談、觀察等方式收集資料與分析。發現個案主要護理問題為：疼痛/與癌細胞轉移有關、身體心像改變/陰道分泌物、因應能力失調/死亡威脅；有未了的心願無法與摯子道別、靈性困擾/罪惡感等。筆者運用舒適護理改善疼痛，及身體清潔改善身體心像，使個案能安穩入睡，並主訴身上不臭了；在因應能力方面，則以會談鼓勵及運用社會資源，並透過醫療小組協助個案主動和家人道別，且預先安排臨終陪伴事項，於住院期間完成個案與案子見面的心願。當個案於瀰留階段，案姊提及個案可能想見案子最後一面，由護理人員聯絡社工協助聯繫學校老師，運用視訊讓她與案子道別並帶著笑容離開人世。此次運用團隊與社區資源，協助癌症末期個案完成最後心願之經驗，期望可作為日後相關個案照護之參考。

This study describes the nursing experiences of a 40-year-old divorced woman with cervical cancer which led to her ineffective individual coping and spiritual distress under the threat of death and incapability to see her only son. The patient had undergone chemotherapy and radiotherapy from February 2003 to October 2010 before this admission. She was admitted due to back pain and vaginal bleeding for one month. The nursing care period was from Oct. 2nd to 24th, 2011, in the internal medicine wards. We conducted an overall assessment including physical, psychological, social and spiritual conditions, and collected data through interviews and observation. The major problems included cancer pain, body image disturbance due to vaginal secretion, ineffective individual coping with the threat of death and incapability to meet her only son. Because of spiritual distress, comfort care was administered to relieve pain and aromatherapy was provided to improve body image so that the patient could sleep well and not sense odor from her body. In terms of individual coping, we encouraged the patient to see her son through the assistance of the medical team and social resources, arranged hospice care at her terminal stage and helped her meet her son during her hospitalization. When the patient was at the dying stage, her sister mentioned that she would like to see her son again for the last time, so we contacted the school teacher of her son through social workers, used video telephone to allow her to see her son for the last time, say goodbye, and eventually die with a smile. We depended on team work and community resources to help the patient have her wish come true at her terminal stage. These experiences can be used as a reference for patient care in the future.